lfredrick123

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About lfredrick123

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  1. Thanks pweslm, I have done all of that. The Colonel wrote a statement since he was the Chief of the environmental command and could attest to it. The other soldiers also wrote statements they saw it being sprayed and questioned what is was but was told it was non harmful. One saw hubby get sprayed as they were going along a tank trail, and then the hygiene surveys pointed out lack of protective equipment, excessible levels of CO2 were too high, and so on. Continuity after service was shown in medical reports and co worker statments. Thr IME Dr said it was more likeley than not related to these incicendnces and why. I have gotten lay affidavits, the letter from the Colonel who sais they were spraying and what, the Industrial hygiene reports, Medical evidence and now this report from VA. Do you all know of anything else I need to add? We also have the IME with ratings that say it was more likely than not due to his exposures. Your VA Problem List contains active health problems your VA providers are helping you to manage. This information is available 3 calendar days after it has been entered. It may not contain active problems managed by non-VA health care providers. If you have any questions about your information, visit the FAQs or contact your VA health care team. Problem: Diastolic heart failure (SCT 418304008) Date/Time Entered: 30 Jun 2016 @ 1200 Provider: __________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Atherosclerosis of artery (SCT 441574008) Date/Time Entered: 13 Nov 2015 @ 1200 Provider: ______________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Benign hypertension (SCT 10725009) Date/Time Entered: 13 Nov 2015 @ 1200 Provider: ____________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Dementia (SCT 52448006) Date/Time Entered: 13 Nov 2015 @ 1200 Provider_________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: MIXED HEARING LOSS, UNILATERAL (ICD-9-CM 389.21) Date/Time Entered: 09 May 2015 @ 1200 Provider: ________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE ________________________________________ Comments: -- Problem: Excessive cerumen in ear canal (SCT 126946000) Date/Time Entered: 06 May 2015 @ 1200 Provider: ______________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Chronic progressive renal failure (SCT 425369003) Date/Time Entered: 12 Jun 2014 @ 1200 Provider: ________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Other dyspnea and respiratory abnormality (ICD-9-CM 786.09) Date/Time Entered: 23 May 2013 @ 1200 Provider_________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: oxygen and nebulizer use Problem: Ataxia (ICD-9-CM 781.3) Date/Time Entered: 06 Sep 2011 @ 1200 Provider: __________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Cerebellar Hemorrhage (ICD-9-CM 799.9) Date/Time Entered: 28 Jul 2010 @ 1200 Provider: ______________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Cerebral Arteriovenous Malformations (ICD-9-CM 747.81) Date/Time Entered: 28 Jul 2010 @ 1200 Provider: ______________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Hypertrophy (Benign) of Prostate with Urinary obstruction (ICD-9-CM 600.01) Date/Time Entered: 28 Jul 2010 @ 1200 ___________________________________________________ Provider: _________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- Problem: Obstructive hydrocephalus (ICD-9-CM 331.4) Date/Time Entered: 28 Jul 2010 @ 1200 Provider: _____________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: ventriculostomy ________________________ Problem: Other Dependence on Supplemental oxygen (ICD-9-CM V46.2) Date/Time Entered: 28 Jul 2010 @ 1200 Provider_____________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: trach 6 liters w/ 35% venturi mask Problem: Other Pulmonary Embolism and Infarction (ICD-9-CM 415.19) Date/Time Entered: 28 Jul 2010 @ 1200 Provider: _________________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: __________________________ Problem: Personal History of Surgery to other Organs (ICD-9-CM V15.29) Date/Time Entered: 28 Jul 2010 @ 1200 Provider: _______________________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: PEG tube 2008 tracheostomy 5/08 removed for 6 weeks, replaced 11/08 VP shunt 10/08 Ventriculostomy 5/08 removal of subdural blood clot 5/08 Repair of AVM 5/08 cataract L eye 2005 _______________________________________________________ umbilica hernia 8/07 Problem: Urinary Incontinence (ICD-9-CM 788.30) Date/Time Entered: 28 Jul 2010 @ 1200 Provider: ___________________ Location: VA Eastrn Colrado HlthCare Sy Status: ACTIVE Comments: -- _________________________________________ VA Notes Source: VA Last Updated: 18 Mar 2017 @ 1102 Sorted By: Date/Time (Descending) VA Notes from January 1, 2013 forward are available 3 calendar days after they have been completed and signed by all required members of your VA health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. Date/Time: 15 Mar 2017 @ 1328 Note Title: CHEST CLINIC CONSULT REPORT (T) Location: VA Eastrn Colrado HlthCare Sy Signed By: _____________________________________ Co-signed By: __________________________________ Date/Time Signed: 15 Mar 2017 @ 1717 Note LOCAL TITLE: CHEST CLINIC CONSULT REPORT (T) STANDARD TITLE: PULMONARY OUTPATIENT CONSULT DATE OF NOTE: MAR 15, 2017@13:28 ENTRY DATE: MAR 15, 2017@13:28:53 AUTHOR: ______________EXP COSIGNER: URGENCY: STATUS: COMPLETED REASON FOR CONSULT: ______________________ _________ is a 77 yo man with a history as below presents for initial care. Doing ok right now. Has been having wheezing intermittently which improves with budesonide and duonebs. Uses vent at night (BiPAP 25/5 with 8LPM bleed in) and is on oxygen during the day 2-2.5 LPM TTO. Continues to have a chronic productive cough of thick, yellow sputum through his trach. No recent blood. No recent fevers > 100.4, chills or night sweats. No nausea, vomiting or abdominal pain. Had a bout of diarrhea that resolved early Feb 2017. Per, his wife, started developing breathing trouble and was diagnosed with COPD in 19_____. Since then, he had been experiencing shortness of breath with exertion and treated albuterol PRN. Subsequently, had a cerebellar dural AVM rupture complicated by chronic hypoventilation necessitating a tracheostomy. He has since then developed multiple infections with most recent sputum cultures 5/2015 growing klebsiella, psuedomonas, and stenotrophomonas. He has since been hospitalized multiple times for pneumonia, (twice in the last year). Since 2008, has had approximately 27-28 hospitalizations. Up about 8 lbs since 12/2016. Oxygen levels have been stable. Per discharge (2/2017): "Mr. Fredrick is a 76yr old male who presented with COPD exacerbation with thick mucous and wheezing, complicating his tenuous resp status with chronic resp failure from prior ICH, requiring trans-trach O2 and nocturnal vent at baseline. He actually was only modestly ill with this, afebrile and without sepsis. Started on IV steroids and frequent nebs along with supportive care. His initial CXR was read as LLL pneumonia. WBC and procalcitonin was negative, however. Subsequent resp pathogens panel was pos for RSV. His abx were stopped. He improved with respect to his wheezing and was stronger on am of discharge as well. Felt to be safe going home with the excellent care from his wife." MEDICAL HISTORY: ?COPD although no history of smoking, but hx of occupational exposure in service. Cerebellar dural AVM s/p hemorrhage 2008 necessitating tracheostomy due to chronic hypoventilation Chronic bacterial colonization due to hypoventilation with 2 hospitalizations in the past year Arteriosclerosis. ? possible pleural plaque related to asbestos exposure. Tics Social history: Worked with a lot of tanks in the Army and had significant exposure to fumes and probably asbestos. Was an artillery tank mechanic. Army 1962-1964. Reserves for four years after that. Baggage handler ____ after that. Smoking: Never smoker Alcohol: Rarely Drugs: None Family history: None TEST RESULTS: CT Hi-res 3/12/17 Impression: Consolidations at both lung bases, infection not excluded Coronary artery calcification. Cardiomegaly Tracheostomy tube VITAL SIGNS: Temp:97.2 F [36.2 C] (12/30/2016 13:10) Pulse:63 (12/30/2016 13:10) Resp:20 (12/30/2016 13:10) BP:102/62 (12/30/2016 13:10) Height:71 in [180.3 cm] (12/30/2016 13:10) Weight:231.7 lb [105.3 kg] (02/22/2017 13:11) Pain:7 (12/30/2016 13:10) Pulse Ox rest: " " walk: PHYSICAL EXAM: Gen: Male patient in NAD HEENT: Trach site with TTO c/d/i CV: RRR RESP: Bilateral rales with no wheezing Abd: S, NT, ND Ext: No edema ASSESSMENT & PLAN: ____________________ is a 77 yo man with a history of cerebellar hemorrhage c/b hypoventilation s/p tracheostomy, colonization with steno, pseudomonas and klebsiella and recurrent pneumonia here to establish care. 1. Hypoventilation - Chronic, unchange d at the moment. - Will likely need some form of suppressive therapy, at this time considering daily azithromycin. Will consider this therapy and check QTc and audiology for evaluation. - Excellent tracheostomy care by wife, continue - Continue budesonide and duonebs. 2. Hx of pleural plaque - Not seen on our CT, seen by Occupational health at ______ and currently monitoring closely. - Does have significant history of asbestos exposure. Pt d/_________________ Fellow Signed: 03/15/2017 17:17 Receipt Acknowledged By: 03/16/2017 22:08 /es/ _______________________, MD Section Chief, Pulmonary Note
  2. Thank you all. I did look up the Spondylosis. Spondylosis is usually caused by the development of arthritis in the spine, which causes the discs and vertebrae to gradually wear down over time.Arthritis of the spine. Heavy lifting for example could cause it over time. This is now 50 years later so I am sure they would say its old age, However the pulmonary issues have been well documented, and I already have a pending DRO/Appeal going on. Hubby had a major stroke in 2008 due to his high blood pressure which he developed in Service. I just received information from a toxicologist that Chlordane (Herbicide and Pesticide) as well as others in the 60's has been linked to hypertension. I also have proof of 2,4,5,T being used by the base, and added proof from Industrial Hygiene reports as well. All of these are suspect in the development of hypertension, not to mention the other things going on. I have an IME already submitted that says the stroke was a result of hypertension, and that it was the cause of the brain bleed causing the vessels to rupture, As well he has sleep apnea, and COPD thanks to Diesel and petroleum exposures, I just was not sure about the coronary artery calcification if that is a result of IHD, along with the enlargement and effusions (Pericarditis)
  3. I took my husband in for a call in to Pulmonary by the CBOC. Here are the results. I am wondering if any of these are attributable to his in service exposure to herbicides etc. Seemed very unusual to have CT scan and then a visit with the Chief of Pulmonolgy fro follow up. They listed the following CT results. Have not seen the narrative yet but CT has confirmed some issues I believe, VA Radiology Reports Source: VA Last Updated: 16 Mar 2017 @ 1005 Sorted By: Date/Time Exam Performed (Descending) VA Radiology Reports are available 3 calendar days after they have been completed. Some studies done at a non-VA facility may not be available or they may not necessarily include an interpretation. If you have any questions about your information please visit the FAQs or contact the provider who ordered the study or your primary care provider. Procedure/Test Name: CT THORAX HIGH RESOLUTION Date/Time Exam Performed: 12 Mar 2017 @ 1253 Ordering Location: VA HlthCare Sy Requesting Provider:_______ Reason for Study: recurrent infections Performing Location: VA _____________ Clinical History: NO VAMC IMAGING PROCEDURES WITHIN LAST YEAR Plain films obtained concurrent with or w/in one month of requested musculoskeletal/spine CT/MRI? NA (STUDY NOT RELATED TO MUSCULOSKELETAL ISSUE) 1. Responsible provider and contact number/pager: Miller 303-929-2145 2. Symptoms/Duration/Physical findings/Working diagnosis: Recurrent pneumnias 3. Briefly describe how results will impact management: characterize, rule out bronchiectasis >> PLEASE NOTE THAT FAILURE TO PROVIDE CLINICAL INFORMATION MAY LEAD TO CANCELLATION OF THE REQUEST AND REFERRAL TO RESPECTIVE SERVICE CHIEF. Page 70 of 73 CREATININE (Includes EGFR) - NONE FOUND ********************************* MAY MODIFY EXAM AT RADIOLOGIST DISCRETION BASED ON CLINICAL HISTORY PROVIDED ON IMAGING REQUEST. ********************************** Radiologist: D_________________ I IMAGING Report Report: CT thorax high resolution Technique: Axial images were obtained through the thorax, sagittal and coronal reformats . Clinical history:Recurrent infections CTDI:19.6mGy IV contrast:None Comparison:None Findings: Mediastinal structures:Tracheostomy tube. Exam degraded by patient motion. No masses or adenopathy in the mediastinum, hila or axilla Upper Abdomenunremarkable Vascular structures:Normal caliber aorta with moderate calcific atherosclerotic disease. Dilated pulmonary arteries. Coronary artery calcification. Enlarged heart size at upper cardial effusion Lung parenchyma:There is opacification at both lung bases which is subsegmental. No fluid overload or pneumothorax Musculoskeletal structures:Maintained vertebral body height and alignment. No lytic or blastic lesions. Mild spondylosis. Impression: Consolidations at both lung bases, infection not excluded Coronary artery calcification. Cardiomegaly Tracheostomy tubePrimary Diagnostic Code: MINOR ABNORMALITY Procedure/Test Name: CT 3D RECON W/O POST PROCESS Date/Time Exam Performed: 12 Mar 2017 @ 1253 Ordering Location: VA Eastrn Colrado HlthCare Sy Requesting Provider: MILLER,YORK E Reason for Study: recurrent infections Performing Location: VA Eastrn Colrado HlthCare Sy 1055 CLERMONT STREET, DENVER 80220 Clinical History: NO VAMC IMAGING PROCEDURES WITHIN LAST YEAR Plain films obtained concurrent with or w/in one month of requested musculoskeletal/spine CT/MRI? NA (STUDY NOT RELATED TO MUSCULOSKELETAL ISSUE) 1. Responsible provider and contact number/pager: Miller 303-929-2145 2. Symptoms/Duration/Physical findings/Working diagnosis: Recurrent pneumnias Briefly describe how results will impact Page 4 management: characterize, rule out bronchiectasis >> PLEASE NOTE THAT FAILURE TO PROVIDE CLINICAL INFORMATION MAY LEAD TO CANCELLATION OF THE REQUEST AND REFERRAL TO RESPECTIVE SERVICE CHIEF. Patient Address: 10861 TENNYSON CT WESTMINSTER, COLORADO 80031 Cell:(720)724-1308 Home:(720)724-1308 CREATININE (Includes EGFR) - NONE FOUND ********************************* MAY MODIFY EXAM AT RADIOLOGIST DISCRETION BASED ON CLINICAL HISTORY PROVIDED ON IMAGING REQUEST. ********************************** F Radiologist: DONAHUE,FRANCIS I IMAGING Report Report: CT thorax high resolution Technique: Axial images were obtained through the thorax, sagittal and coronal reformats . Clinical history:Recurrent infections CTDI:19.6mGy IV contrast:None Comparison:None Findings: Mediastinal structures:Tracheostomy tube. Exam degraded by patient motion. No masses or adenopathy in the mediastinum, hila or axilla Upper Abdomenunremarkable Vascular structures:Normal caliber aorta with moderate calcific atherosclerotic disease. Dilated pulmonary arteries. Coronary artery calcification. Enlarged heart size at upper cardial effusion Lung parenchyma:There is opacification at both lung bases which is subsegmental. No fluid overload or pneumothorax Musculoskeletal structures:Maintained vertebral body height and alignment. No lytic or blastic lesions. Mild spondylosis. Impression: Consolidations at both lung bases, infection not excluded Coronary artery calcification. Cardiomegaly Tracheostomy tube Primary Diagnostic Code: MINOR ABNORMALITy. Anyone have any ideas? Recently recieved a call from RO person telling me she was expediting his claim through the DRO process, then we got the call to go in for the CT and follow up, unusual to meet with the Chief of Pulmonology.MD . Started the meeting with a young DR that then left and in came the Chief. What do you think guys?
  4. ICD 9 and SCT are codes used in the insurance industry to identify a specific diagnosis. The Systematized Nomenclature of Medicine — Clinical Terms (SNOMED-CT) was created by the College of American Pathologists (CAP) to represent medical terminology in electronic health records (EHRs) For many years providers have been doing a good job of summarizing their patients’ current and relevant medical conditions on a “problem list”. Typically this list is located within the first page of a patient’s chart, ideally enabling the medical provider to quickly assess the current and past medical issues of the patient. While the intent is clear, the methodology is not – many providers still using paper charts may use acronyms to express a clinical condition (e.g. MS or AA) or they may not add the date of the diagnosis and/or its resolution. For those providers who utilize EMRs (electronic medical records) the problem may be more complex due to the lack of interoperability between different EMR systems. Enter Meaningful Use Stage 2 and SNOMED. Stage 2 Meaningful Use criteria expands upon the Stage 1 requirements to further improve and utilize healthcare IT and EMRs to provide consistent, collaborative care among different provider groups for any given patient. This means that these electronic systems need to talk to each other and more importantly they need to understand each other. The only way for them to reach this understanding is to speak a common language. Stage 2 of Meaningful Use has defined this language as SNOMED-CT – specifically for the problem list within a patient’s chart. This is an acronym for Systematized Nomenclature of Medicine – Clinical Terminology. It is recognized throughout the US and internationally, and it is available at no cost through the National Library of Medicine. Using SNOMED-CT enables providers and electronic medical records to communicate in a common language, thus increasing the quality of patient care across many different provider specialties. ICD-9 was and is used as a diagnosis and procedure coding system. Again specifically outlining the diagnosis and the process followed for a precedure performed. Its now an old system and is supposed to have been upgraded to ICD-10 this last year,
  5. Same thing they did with Vietnam and Cold War Vets. The only thing you can do is fight and beat them at their own games.
  6. Hi Mike...we just went through the fiduciary thing ourselves. Not to worry, if you have officially nominated your GF, she has a clean background and credit report. You should call ebenefits and speak to someone there to help you. They can check on where the awards are and if you have started the fiduciary process. The field examiner will come out and check for safety and soundness, and then develop a budget for you if you dont have one already. We did and I gave it to him. The process takes awhile but is not that difficult really, just nerve wracking. You do not need to be service connected to get medical help ( you already are at 70%) just go to the VA hospital and get your id and an enrollment done. Any veteran with a honorable discharge can go there. They can help get you on track but make sure you have your GF with you as an advocate. It took us a short time but we got in. As for the $ your owed you need to call to track that down. Ebenefits should have ypur information under the payments tab and if not there then look at your profile for what account you have set up if any. I would call because they can check right away. Most of all get the help you need, you can call the social workers there and they can helo you get on your feet. I will say some extra prayers tonight you get this quickly. Its not insurmountable, just arduous.
  7. Must be contageous as we have it too. Wonder if Obsessive Compulsive Disorder would work? (Ha Ha) Really do not understand why it would be so difficult to post an updated status once every 6 months. I know they have alot going on but really its not helping their volumes at all to force people to call in for it.
  8. Hi Berta,

    Thank you for all you do for Veterans, I am wondering if you could address this. I am helping my husband with his claims and pending appeals. He has a multitude of issues following a debilitating hemmorhagic stroke in 2008. We got his service records over 5 different requests that provided his service medical treatement records and service records, I had an IMO done for him with his medical records and his personal records. The STR show he had an elevate BP at entry of 140/90 which was very high for someone 22resting. After ecercise it was 148/94. it continured over the years and for any years the docs kepot telling him diet and exercise which he did do all the time. In fact he was riding his bike as usual, when he collapsed. His BP has gone as high as 193/100 or more on occassions, In 2004 long before the stroke he was diagnosed with COPD, even though he never smoked, He has gone 2 times in service to the dispensary but dont know what for, since there are no records, He says because the pesticide fumes made him sick that they were spraying in the facilities and around the base. I see a Dispensary notation but no records in his C file. Also no records on injections they gave, Just that he was there. His dental records are there, and his eye glass records but not the 2 visits that are showing. Also found a record of his hand injury and sutures. At discharge the record shows nothing other than a lower BP reading,and 0's accross the audiogram( he says he never had an exam) and to boot I found in the C file a lab document showing a retake of a urine with a Creatinine of 1.4 (Kidney disease?) I asked the Army for records they insisted they had none on pesticides. I did my own digging found a retired COL. who was Chief of Environmental Command there and he told me they were spraying in 1962-1963 Diazinon. Mallathion,Chlordane, DDT, Lindane, Nicotine Sulfate, 2,4,5,-T along with 2,4,D. He put that in writing, I also searched further found out that the baserecieved a shipment of Phosgene and it was just before his arrival. They had a chemical weapons training field they had used land mines filled with mustard in the 40s that they used for training, And then I got the Industrial Hygiene Surveys that ran from 1956.57.58.59.60.61.63.63 all which confirmed heavy carbon monoxide levels in training facilities (and in tank exhaust) along with none other IH concern about the pesticides which were sprayed by 5-8 men, 8hrs per day from April until October, IMO doc issued the following report: I could not get the name to redact so I have just ssent it to you in whole, If you can change it there I would appreciate it. My system is old, and my scanner just files it as is. At any rate I am wondering your opinion on this case now, All have been sent to VADr Ellis MD Nexus Letter Nov 20 2015 (3) - Copy.jpgDr Ellis MD Nexus Letter Nov 20 2015 (3) - Copy.jpgDr Ellis MD Nexus Letter Nov 20 2015 (4) - Copy.jpgDr Ellis MD Nexus Letter Nov 20 2015 (4) - Copy.jpgDr Ellis MD Nexus Letter Nov 20 2015 (5) - Copy.jpg

     

    Dr Ellis MD Nexus Letter Nov 20 2015 (2) - Copy.jpg

    1. Berta

      Berta

      I don't feel Dr. Ellis's  medical rationale is strong enough for some of these issues.

      Did he fully opine on the MRI of the CVA?

      Did he rule out ischemic heart disease as potential cause of stroke?

      Or transcient ischemia due to diabetes causing stroke?

      In case the stroke was not hemorrhage at all but instead ischemic ....a mistake VA made when they initially diagnosed my husband's stroke.

      HBP can contribute to stroke as my recent CUE 1151 award reveals. But I don't think that evidence would help you.

      I think you should post in the main forum where others can also opine on this. I hardly ever read anything in my profile,except to find my last posts.

      We would need to see what his SC ratings are now and what for, as well as a  copy of any denials he received that are being appealed.The C file, name ,address ect. can be covered prior to scanning and attaching to a post in the main forum.

      A copy of the C & P exams would be good too. in the public forum....where more can opine on all this.

       

    2. lfredrick123

      lfredrick123

      Thanks Berta, I will post and make sure the evidence supports this info.

  9. Dont know if this will help, but husband served in a tank squadron as a turret artillery repairman. Tanks were known to have heavy Carbon Dioxide from the diesel fuels in the turret and in the smoke and obliterants. We were digging for military evidence and found industrial hygiene surveys done at the base he was at that had multiple years of reporting that showed excessive levels of Carbon Monoxide in the training areas and heavy pollution levels. You might check to see if there were any surveys done at your particular base that would show it as a health hazard, and if they were doing anything at all to help. In husbands case he has COPD from it (never smoked himself) and severe lung problems now thanks to exposures and an eventual stroke. At any rate I found a report from Dr Grace Ziem on Hydrocarvons, fuels exposures. Here it is. If you will look her info up Dr. Grace Ziem MD she is an Occupational doc who worked as a consultant to VA and there may be more info on your cancer problems in her materials. Here is what I found: COMBUSTION PRODUCTS Being near busy traffic or vehicle exhaust causes exposure that affects lung function. 1 This is worse for those with longer exposure, such as house near traffic.1 Very small vehicle particles can easily enter an indoor environment. 1 Exposure to diesel exhaust causes lung inflammation even in healthy people. 2 Risk is greater with longer exposure as well as higher intensity. Even higher risk occurs with indoor exposure to idling vehicles.3 DANGER BELOW EXPOSURE LIMITS Harmful health effects occur from combustion product particles even at below government and commonly used exposure levels. 4 Particulate pollutants (such as combustion products) cause and exacerbate illness at levels below EPA and WHO guidelines.5 There is a direct dose-response relationship between levels of combustion particle exposure and death rate. 4 Recent scientific research shows body damage at very low levels of carbon monoxide, suggesting there is no known safe level of carbon monoxide exposure.6 HAZARDOUS GASES Combustion gases contain irritants7 8 9 and toxins.10 11 Combustion products of fuels (oil, gasoline, diesel, propane, etc.) contain the irritant oxides of nitrogen and for most fuels, oxides of sulphur. Repeated modest and even "tolerable" level irritant exposure,8 or higher level single8 or repeated9 irritant exposure can cause permanent or long term reactive airway disease rendering the individual with long-standing heightened susceptibility to exacerbating symptoms from future irritant exposures.7 9 Combustion products such as vehicle exhaust and smoke release benzene, a potent cancer agent, and these exposures increase cancer risk.10 Combustion products also contain carbon monoxide, which can cause sensitization and affect memory and learning.11 Carbon monoxide is toxic to brain/nerve cells, the heart, and other body muscle.6 Carbon monoxide exposure can cause long term neurologic damage.6 Chemical exposure can also interfere with detoxification. 11 LUNG DAMAGE FROM COMBUSTION PARTICLES Combustion particles when inhaled can cause allergic effects and other chronic respiratory damage.3 12 13 14 Combustion particles can accumulate in the lungs. 15 Gases, vapors and other air pollutants cling to particles and the particles then carry these substances into the lungs.16 They persist longer, because particles are harder to clear from the lungs. Very small particles cause lung inflammation, damage lung cells, and form lipid peroxides in lung tissue. They can also enter the body through the lungs and/or cause lung scarring. 17 Combustion Products Page 2 of 5 Fine particulates deposit in the respiratory tract.14 Smaller particles (under 2.5 microns) deposit in the deep lung sacs (alveoli).14 They cause inflammation that makes lungs more permeable (to toxins, other particles, etc).14 Fine particles can act as a physical stressor, increasing norepinephrine (adrenalin) and adrenal cortisol (body stress hormone) levels.14 EXPOSURE SOURCES All combustion releases carbon monoxide, and most combustion releases particles as well. Burning landfills and industrial releases are major sources. Vehicles are a problem especially with frequent/repeated and/or heavy traffic exposure, gas or kerosene space heaters, gas appliances and tobacco sources release indoor carbon monoxide.6 DIESEL Exposure to diesel exhaust causes eye and respiratory irritation and can lead to chronic respiratory damage.3 These very small particles entering the blood stream can impair normal function of the autonomic nervous system.17 Repeated, chronic diesel exhaust exposure can also cause brain damage with documented impairment in memory and other cognitive functions, as well as impaired balance, reaction time and other neurophysiologic functions.3 HEART DAMAGE Particles can cause changes in EKG (electrocardiogram) tests showing (reduced blood/oxygen supply and/or inflammation.18 Exposure to combustion particles and gases cause excess cardiovascular disease risk 19 20 21 and risk of death from stroke and other causes.21 HOW COMBUSTION PARTICLES CAUSE HARM When fine chemical particles are breathed in, they can pass into the blood stream and be distributed to many other body organs and cells.20 Chemical particles in those other locations also cause inflammation in those locations. They cause immune changes. They also cause toxicity20 and increased need for antioxidants due to formation of tissue-damaging substances called free radicals.20 Bigger particles breathed can penetrate and be deposited in the larynx (voice box), trachea and larger airways14 causing inflammation.14 22 Combustion particles impair lung function.23 Ultrafine particles in large numbers are present in vehicle emission, worse in diesel. These particles have a high ability to attach to lung sacs (alveoli), cause inflammation. They also enter the blood stream16 and have a large surface area to absorb gases and vapors.16 They thus carry other vapors into the body. COMBUSTION PRODUCT EXPOSURE DEPLETES ESSENTIAL ANTIOXIDANTS AND NUTRIENTS Carbon monoxide exposure11 24 25 26 can produce excess nitric oxide in the body 11 24 25 and NMDA activation.25 27 Both of these lead to inflammation.26 28 29 30 31 Particles also cause inflammation and increased nitric oxide. 22 32 These changes all deplete nutrients and require nutrients for repair.28 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Combustion Products Page 3 of 5 This damage can be reduced by treatment with glutathione.12 Fine combustion and other particles can cause increase in the respiratory inflammation marker, exhaled nitric oxide.22 Excess nitric oxide depletes cobalamin (B12) and needs hydroxocobalamine as a scavenger. 36 37 OTHER BODY DAMAGE They can cause damage to genetic material (DNA).10 This is measured by a substance called 8-hydroxy-2-deoxyguanosine.16 This type of DNA damage could lead to increased cardiovascular and pulmonary disease, risk of mutations and cancer.16 Diesel exhaust increases lung cancer.55 They also damage essential lipids,16 causing damage to cell membranes and membranes around internal structures inside cells. Examples of these vital structures are ribosomes making proteins, mitochondria producing energy, etc.). They damage myelin in the brain and nervous system. Exposure to vehicle traffic exhaust significantly increases body exposure to these particles,16 and increased DNA damage can be measured after such exposure.16 It is worse with heavier traffic16 e.g., commuter, highway traffic, etc.). Other studies confirm a correlation between DNA damage and exposure to small particles. Inhaled ultrafine particles can penetrate through the lung and within an hour are able to penetrate cells and affect energy-generating mitochondria and other structures within body cells.16 56 Carbon monoxide can also cause inflammation of blood vessel linings.57 This can impair oxygen supply to the brain, heart and other organs. BURNING SYNTHETICS Persons exposed to combustion products from flame-retardants in plastics, electronics, fabrics and other materials can develop permanent brain and neurologic damage.58 Deca is the most widely used flame retardant and during combustion and other exposure breaks down to brominated compounds. These persist in the body for decades and are banned in the European Union and California.)58 1 D Sugiri, etal, “The influence of large-scale airborne particle decline and traffic-related exposure on children’s lung function,” Env Health Persp 114:282-288, 2006. 2 S Dubowsky Adar, etal, “Ambient and microenvironmental particles and exhaled nitric oxide before and after a group bus trip”, Env Health Persp 115: 507-512, 2007. 3 KH Kilburn “Effects of Diesel exhaust on neurobehavioral and pulmonary functions,” Archiv Env Health, 55: 11-14, 2000. 4 E Samoli, etal, “Particulate air pollution and mortality: findings from 20 US cities, N Eng J Med 343: 1742-1757. 5 SV Glinianaia etal, “Does particulate air pollution contribute to infant death? 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Hope this helps
  10. We sent in a timely NOD and Request for DRO Review. That is all that was available on the form, It is written Decision Review Officer (DRO) Review Process or Traditional Appellate Review Process as the options. We chose the DRO Review process. Hopefully this will get us to a hearing on the matter rather than them just reviewing the decision. Any suggestions? We are beyond the one year time period now. Or should we send a certified letter to them confirming the request and DRO Hearing.
  11. Dr Ellis did my husbands as well, I sent him the medical records, hospital summaries, consults, discharge reports, and proof of exposures as well. We got our IMO back in about 2 weeks time and it was very thorough. We sent it on to VA but remains to be seen if they will ever review it. They are very slow in dealing with anything.
  12. We are waiting on a sleep apnea claim as well. Hubby had the study and clearly because he is a CO2 retainer and has hypoxia on top, it has caused Respiratory failure. He no long sleeps just 4 hrs but a full 9 , his snoriing had subsided along with the night terrors, His heart has improved and he if feeling better as well. He has a tracheostomy and so his maching attaches diredtly to that. Had to juno through mounds of hoops to get it however and many questions from Drs about it. I actually had to go with him into a trach hospotal for 3 weeks  with him to train in its use. Its been a big help.

    1. EODCMC

      EODCMC

      Wow, my heart goes out to you and your husband. I wish you well.

    2. EODCMC

      EODCMC

      BTW, my wife is hailing the CPAP. I have not woken her once since adjusting to it. For that reason alone, it is worth it. Had I know, I would have started years ago. 

  13. This is what we went through too. Eventually I figured we would be waiting for ions, so we sent a certified return reciept FOIA and Privacy Act request to them again, but this time also sent a letter to the General Counsel's office and told them we would be complying with the FOIA and Privacy Act Laws and if necessary we would file in Federal Court to get the C file, We got the Cfile within a few days, Its rediculous when you go months without even an acknowledgement. And clearly I felt like they were deliberately doing this to interfere with my husbands ability to get an independent medical exam, because you need the files to give to them.I looked the VA rules on FOIA requests and followed the law as it mandated,
  14. We waited almost a year on my husbands file and according to them when we called it could take up to three years. Since I had sent them the request cerified mail and a Privacy Act Request originallym I sent a 2nd request certified just prior to the 1 year mark. When they failed to answer I sent a final request through the Office of the General Counsel and got it in less than a week later, Know they are busy, and no doubt a thankless job, but veterans are waitiing for help, and must have their documents.
  15. First of all request your entire claims file including all of your VA and Service Treatment records from the date of your entry into the service and up to present date. You need to include a photocopy of your driver's license and the necessary VA form you need by going to the VA medical center for your area. You will see a patient portal and when you click on it, it. Will take you to how to request medical records. Fill it out and sign it and send with the. ID. It would be better if you could go in person but if not send it to the health information officer at the med center,make a copy of the request and letter and send it to the claims processing center too. These have to go certified return receipt. Keep a copy for yourself too for your file. This will request your health records they have at VA. This is all part of Hippa regulations and the Privacy act. If you don't get it in 30 days, send again a 2nd request certified. If you're still waiting then call the health information officer personally. Now for your personal records I would call Social Security and ask for a complete set of your file undr a GOIA and Privacy Act request. They should have all your prior records. Generally the costs are less than going to every doctor. If you need help the Vet centers. Can help.